Palliative care should be offered far earlier during cancer treatment

​A large international commission of cancer experts recommends integrating alleviating palliative care into oncology, and offering such care early during a cancer treatment pathway. "In Denmark, palliative care is only an option for terminally ill patients," said Per Sjøgren, Professor in palliative medicine.

There is a need to completely rethink alleviating palliative care for cancer patients. This is the message from a 66-page report published by the prestigious journal The Lancet Oncology. The journal asked a large international expert commission to make recommendations on how to strengthen the integration of oncology and palliative care. Their main conclusion is that there is generally too little collaboration between oncology and palliative care, and in order to enhance such collaboration, all areas - from treatment to research and education - should be integrated more closely.

From Rigshospitalet, Per Sjøgren, Consultant and Professor in palliative medicine at the Section of Acute Pain Management and Palliative Medicine, and Geana Kurita, nurse and postdoc at the Multidisciplinary Pain Center, were on the commission. They wrote a chapter in the report on how to improve education and training for cross-disciplinary palliative care staff.

"Overall, the key message of the expert commission is that palliative care should be integrated far earlier during cancer treatment pathways, while patients are still in oncological or surgical treatment. This will no doubt lead to better quality of life for patients, and perhaps even improve the survival rate," said Professor Per Sjøgren.

The report also points out that, in most high-income countries, palliative medicine has become or is becoming a specialist area in its own right.

Palliative care as the 'final call'

Per Sjøgren believes that palliative care and oncology in Denmark are 'care silos', and he hopes that the initiative from The Lancet Oncology can change this culture. Also at Rigshospitalet.

"The status of palliative care in Denmark is that it is the final call before the patient dies. However, palliative care is relevant for more than half of all cancer patients, and many countries are beginning to take action. The recommendation of the report is that to bridge the divide between oncology and palliative care during a cancer treatment pathway. I think we should take up this recommendation at Rigshospitalet. Apart from oncology, a number of other areas could benefit from integrating palliative care in patients' courses of treatment, for example cardiology and nephrology. But of course, adequate resources must also be available," said Professor Per Sjøgren.

He explained that, early during their treatment, cancer patients may experience psychological sequela such as anxiety and depression, and usually they also have a myriad of physical symptoms, e.g. pain, nausea, and extreme fatigue.

"Palliative care can also be supportive treatment, in the sense that we can help patients to better well-being during their treatment pathway. So early palliative care intervention could thus also help patients in long chronic treatment pathways and even patients who survive their cancer," said Per Sjøgren. 

Greater need for palliative care

In 2012, the Section of Acute Pain Management and Palliative Medicine was placed administratively under the Department of Oncology, but today the Section has both clinical obligations and research obligations with a number of other clinics at Rigshospitalet.  This opens up several opportunities for integrated collaboration.

"In this way, the report can serve as a model for this kind of integrated functions. Overall, around 8,000 Danish cancer patients receive specialised palliative care every year. But as the population is ageing, and palliative care is spreading to areas other than oncology, the need to prioritise palliative care is growing rapidly," said Per Sjøgren.

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